A gift of life or a denial of choice?

Three years ago I had a liver transplant. If it hadn't been for the generosity of my donor, I would be dead. Polly Toynbee (Living people matter. When you're dead, you're dead, January 15) referred to how "people die, often in terrible suffering, waiting and hoping for a kidney or a heart ... only to be disappointed". The same happens to liver patients and increasingly so. Waiting times in the liver unit I attend have increased from five months in 2004, when I received my transplant, to two years. The key reason is a lack of organs and this situation is completely preventable.

While Toynbee rightly pointed to some of the misinformation that has prevented a humane shift to a policy of presumed consent, it is also vital to be clear that such a policy would not involve the indiscriminate removal of organs without any involvement of loved ones in the decision. They will be consulted and supported to make the right decision in a manner that will ensure that organ donation remains the unique, extraordinary gift that it is.Harry Ferguson Taunton, Somerset

Consent rates for organ donation in countries where the system is to opt in are far lower than consent rates where one has to opt out. In Germany (12%), the Netherlands (27.5%), Denmark (4.25%) and the UK (17.17%), where one must opt-in, consent rates are all well below those in Austria (99.98%), Belgium (98%), France (99.91%), Hungary (99.97%), Poland (99.5%), Portugal (99.64%) and Sweden (85.9%), where one must opt out.

These figures show that the default makes a huge difference to donation rates which is why it should be changed.

Those opposed to the proposal ignore the fact that people will be able to opt out if they wish.Professor Peter AytonCity University

I agree that we should have to opt out of organ transplant, but even under the present legislation, I suspect that hospitals do not do all they might to help alleviate the current organ shortfall. To be 100% effective, a donor programme needs proper coordination between doctors, non-medical staff and the patient's relatives.

My wife died of cancer some five years ago in the Macmillan unit at the Queen Elizabeth hospital, King's Lynn. At the time I reminded staff that she had signed a donor card. However, I received no subsequent communication about whether her organs had been considered useful. This lack of communication suggested to me, rightly or wrongly, that no one thought the organ transplant programme important or even investigated the possible use of any of her organs. If so, what a dreadful waste.Peter Bird Fakenham, Norfolk

What breathtaking arrogance Polly Toynbee expresses in her polemic in favour of Gordon Brown's decision to support presumed consent for organ donation. Toynbee's argument is superficial and simplistic; there are no moral or ethical considerations here. It is obvious that the jury is still out on human transplants, as Toynbee herself concedes when she discloses that of the 90% who theoretically support transplants, only 25% register as donors. People are still concerned as to the ethics and morality of "organ harvesting".Marion PeasnellLancaster

I wonder whether our prime minister is ever going to announce as strong an initiative into stem cell research as he's done with the idea of compulsory organ seizures? Stem cell research offers a potentially far healthier and more effective source of grown tissue, leading to the growth of replacement organs. So where is the investment in the kind of science that could transform the world?Michael BondFounder, polwatch.org

The first necessary change in the law is to prohibit the next of kin of the deceased being able to override the deceased's choice to be a donor. After that we can consider bringing in an opt-out system.Dr Farah MendlesohnLondon